Oppositional Defiant Disorder (ODD)

Children and adolescents with oppositional defiant disorder (ODD) often have difficulty controlling their emotions, often argue and defy rules, and can be spiteful and vindictive when they feel slighted.

ODD is estimated to be present in about 3% of children, although some research studies show prevalence rates as high as 11%. Boys are more likely than girls to be diagnosed with the disorder. Children with ODD often have co-occurring ADHD. They are also at elevated risk to develop later co-occurring conditions. Those with high irritability/anger are at elevated risk for developing anxiety and mood disorders, while children diagnosed with ODD early in childhood are at greater risk in developing conduct disorder by the time they reach adolescence.

Children with ODD can often present with dysregulated emotions, characterized by persisting anger and irritability, being resentful toward others or past events, being very short-fused and easily frustrated by seemingly little things, and, in younger children, throwing frequent temper tantrums. Parents and teachers are often challenged by children with ODD since they usually argue when they cannot get their way and get in frequent power struggles over daily routines and limits. They may also often purposely ignore commands from authority figures, actively refuse to comply with rules, or blatantly break established rules in a given situation. These children can also purposefully annoy or provoke others frequently to either seek attention or get a reaction from them. They also have difficulty accepting responsibility when they get in trouble and will usually deny wrong-doing or blame others for their actions. A smaller subset of ODD children will show higher levels of vindictiveness and will attempt to get back at others with some form of aggression when they feel slighted or provoked.

It is noteworthy that a child or adolescent does not need to exhibit all ODD symptoms in order to meet criteria for the disorder. They also do not need to show symptoms consistently in multiple settings - one setting of persisting ODD symptoms is all it takes. Oftentimes, children will show highest ODD symptoms at home, while school and social contexts are less affected. To no surprise, the more environments that are affected by the child's ODD, the more severe the condition and the worse the prognosis.

Many parents find it very challenging to manage the behavior of ODD children. They may find that their child's misbehavior has caused damage to the parent-child interaction; they may also sometimes resort to ineffective and coercive parenting tactics in effort to enforce compliance. Unfortunately, both of these interaction patterns can cause a vicious cycle of defiant behavior and deteriorated parent-child interaction, making the child's symptoms worse over time if left untreated. It is for this reason that parent training is such an integral part of treating ODD children.